Instruments and methods for complete plantar plate repairs

ABSTRACT

Surgical repair systems and techniques for plantar plate repairs. The surgical repair systems and methods reconstruct the plantar plate through a dorsal incision. The surgical repair system embodies a variety of instruments that provide visualization and access to the plantar plate using suture to complete the repair. The repair system may include some or all of the following instruments: a metatarsal head pusher employed in open surgical space, to move the “capital fragment” in a controlled manner; a suture retriever instrument and a suture retriever funnel (sleeve); a suture passer such as a Mini Scorpion DX and accompanying needle, or a variety of shaped Micro Suture Lassos; a measuring guide; and a small joint distractor.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 13/724,600,filed Dec. 21, 2012, which claims the benefit of U.S. ProvisionalApplication No. 61/583,915 filed Jan. 6, 2012, the disclosures of whichare incorporated by reference in their entirety herein.

FIELD OF THE INVENTION

The present invention relates to surgical devices and methods, and moreparticularly, to systems and methods for complete plantar plate repairs.

BACKGROUND OF THE INVENTION

The second metatarsophalangeal (MTP) joint is stabilized by acombination of static resistance provided by the plantar plate andcollateral ligaments, and the dynamic pull of the intrinsic flexors. Theplantar plate is rectangular to trapezoidal and originates on themetatarsal head through a thin synovial attachment, just proximal to thearticular surface, and inserts on the base of the proximal phalanx.Deterioration of the plantar plate often leads to instability of thesecond MTP joint.

As the principle stabilizer of the MTP joint, the integrity of theplantar plate is essential to stabilize the proximal phalanx of thelesser toes, and its attrition often results in metatarsalgia, plantarswelling, hammertoe deformity, and lesser toe subluxation. Surgicalrepairs of plantar plate ruptures have evolved with increasedappreciation of the anatomy. Primary repairs involve directvisualization of the plantar plate injury and may involve an incisionthrough the plantar of the foot which may lead to complications duringhealing. Other procedures that address MTP instability include the useof anchors, extensor tendon lengthening, flexor tendon transfers,metatarsal osteotomies and total joint implants, among others.

SUMMARY OF THE INVENTION

The invention provides surgical repair systems and techniques forcomplete plantar plate repairs. The surgical repair systems and methodsof the present invention reconstruct—through a dorsal incision—theplantar plate that leads to the instability of the second MTP joint,restoring the normal alignment of the joint, and minimizing healingcomplications.

The surgical repair system of the present invention embodies a varietyof instruments that provide visualization and access to the plantarplate using suture to complete the repair. The repair system may includesome or all of the following instruments: a metatarsal head pusheremployed in open surgical space, to move the “capital fragment” in acontrolled manner; a suture retriever instrument and a suture retrieverfunnel (sleeve); a suture passer such as a Mini Scorpion™ DX suturepasser and accompanying needle, or a variety of shaped MicroSutureLasso™ suture passers; a measuring guide; and a small jointdistractor. Additional instruments may include drill bits and k-wires asare known for performing surgery. These specialized instruments (i)access an open surgical space and move the “capital fragment” in acontrolled/precise manner; (ii) reach into the surgical space and passsuture either by using the Mini Scorpion™ DX suture passer or MicroSutureLasso™ suture passers; (iii) pull suture through the bone tunnelsenabling reattachment of the plantar plate (ligament) to the bone; and(iv) confer a successfully tensioned plantar plate.

The plantar plate repair method of the present invention comprises interalia the steps of: (i) intraoperatively demonstrating a plantar platetear (second metatarsal head is inferior) in the second MTP joint bydistraction; (ii) transfixing the plate with a suture passer (miniScorpion™ DX or micro SutureLasso™ suture passers) (just proximal to thetear) and pulling a suture through the plantar plate; (iii) positioningsutures (preferably two sutures with four tails) at the distal aspect ofthe plantar plate (not yet passed through the phalanx); (iv) passing thesuture through the dorsal to plantar drill hole; (v) fixating ametatarsal shortening osteotomy (Weil osteotomy) before tying thesutures; and (vi) tying the sutures with the toe in plantar flexion. Atleast one of the above-noted steps is conducted with at least one of theinstruments of the repair system of the present invention.

These and other features and advantages of the invention will be moreapparent from the following detailed description that is provided inconnection with the accompanying drawings and illustrated exemplaryembodiments of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1(a) illustrates a partial cross-sectional view of a Mini Scorpion™DX suture passer of the present invention employed for plantar platerepair.

FIG. 1(b) is a top view of the Mini Scorpion™ DX suture passer of FIG.1(a).

FIG. 1(c) is a perspective view of the Mini Scorpion™ DX suture passerof FIG. 1(a).

FIG. 2(a) illustrates a perspective view of a Mini Scorpion™ DX suturepasser needle with molded handle employed with the Mini Scorpion™ DX ofFIG. 1(c).

FIG. 2(b) is a top view of the Mini Scorpion™ DX suture passer needle ofFIG. 2(a).

FIG. 2(c) is a partial cross-sectional view of the Mini Scorpion™ DXsuture passer needle of FIG. 2(a).

FIG. 2(d) is a left side view of the Mini Scorpion™ DX suture passerneedle of FIG. 2(c).

FIG. 3(a) illustrates a top view of a Micro SutureLasso™ suture passeraccording to an exemplary embodiment of the present invention (plantarplate pig-tails), and employed for plantar plate repair.

FIG. 3(b) is a lateral view of the Micro SutureLasso™ suture passer ofFIG. 3(a).

FIG. 3(c) is an enlarged view of detail A of FIG. 3(a).

FIG. 3(d) is a right side view of detail A of FIG. 3(c).

FIG. 4(a) illustrates a top view of a Micro SutureLasso™ suture passeraccording to another exemplary embodiment of the present invention(Micro SutureLasso™ suture passer needle), and employed for plantarplate repair.

FIG. 4(b) is a cross-sectional view of the Micro SutureLasso™ suturepasser of FIG. 4(a).

FIG. 4(c) is an enlarged view of detail G of FIG. 4(b).

FIG. 4(d) is an enlarged view of detail H of FIG. 4(b).

FIG. 4(e) is an enlarged view of detail J of FIG. 4(a).

FIG. 5(a) illustrates a top view of a Micro SutureLasso™ suture passeraccording to another exemplary embodiment of the present invention, andemployed for plantar plate repair.

FIG. 5(b) is a lateral view of the Micro SutureLasso™ of FIG. 5(a)suture passer.

FIG. 5(c) illustrates a top view of a Micro SutureLasso™ suture passeraccording to another exemplary embodiment of the present invention, andemployed for plantar plate repair.

FIG. 5(d) is a lateral view of the Micro SutureLasso™ suture passer ofFIG. 5(c).

FIG. 6(a) illustrates a top view of a Micro SutureLasso™ suture passeraccording to another exemplary embodiment of the present invention, andemployed for plantar plate repair.

FIG. 6(b) is a cross-sectional view of the Micro SutureLasso™ suturepasser of FIG. 6(a).

FIG. 6(c) is a perspective view of the Micro SutureLasso™ suture passerof FIG. 6(a).

FIG. 6(d) is an enlarged view of detail B of FIG. 6(c).

FIG. 6(e) is an enlarged view of detail A of FIG. 6(b).

FIG. 7(a) illustrates a top view of a Micro SutureLasso™ suture passeraccording to another exemplary embodiment of the present invention, andemployed for plantar plate repair.

FIG. 7(b) is a lateral view of the Micro SutureLasso™ passer of FIG.7(a)

FIG. 7(c) is an enlarged view of the most distal end of the MicroSutureLasso™ suture passer of FIG. 7(a).

FIG. 8(a) illustrates a lateral view of a Micro SutureLasso™ suturepasser according to another exemplary embodiment of the presentinvention, and employed for plantar plate repair.

FIG. 8(b) is an enlarged view of the most distal end of the MicroSutureLasso™ suture passer of FIG. 8(a).

FIG. 9(a) illustrates a side view of a Suture Retriever of the presentinvention employed for plantar plate repair and according to anembodiment of the present invention (with a stopper).

FIG. 9(b) illustrates a side view of a Suture Retriever of the presentinvention employed for plantar plate repair and according to anotherembodiment of the present invention (without a stopper).

FIG. 10(a) illustrates a frontal view of a Suture Retriever funnel(sleeve) employed with the Suture Retrieval of FIGS. 9(a) and 9(b).

FIG. 10(b) is a cross-sectional view of the Suture Retriever funnel(sleeve) of FIG. 10(a), taken along line A-A of FIG. 10(a).

FIG. 11(a) illustrates a schematic top view of a plantar plate Pusher(which may be reusable or disposable) of the present invention employedfor plantar plate repair.

FIG. 11(b) is a side view of the plantar plate Pusher of FIG. 11(a).

FIG. 11(c) is an enlarged view of the distal end of the plantar platePusher of FIG. 11(a).

FIG. 11(d) is a left side view of the plantar plate Pusher of FIG.11(c).

FIG. 11(e) is a cross-sectional view of the plantar plate Pusher of FIG.11(d), taken along line A-A of FIG. 11(d).

FIG. 12(a) illustrates a schematic top view of a plantar plate MeasuringGuide (which may be disposable) of the present invention employed forplantar plate repair.

FIG. 12(b) is a side view of the plantar plate Measuring Guide of FIG.12(a).

FIG. 13 illustrates a plantar plate Distractor of the present inventionemployed for plantar plate repair.

FIGS. 14(a)-(d) illustrate subsequent steps of a method of plantar platerepair according to an embodiment of the present invention.

FIGS. 15(a)-(f) illustrate another series of subsequent steps of amethod of complete plantar plate repair according to another embodimentof the present invention.

FIGS. 16(a)-(c) illustrate a series of steps of a plantar plate repairwith a suture retriever without a funnel.

FIGS. 17(a)-(c) illustrate a series of steps of a plantar plate repairwith a suture retriever with a funnel.

FIGS. 18-42 illustrate another series of steps of a method of completeplantar plate repair according to another embodiment of the presentinvention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention provides systems and methods for plantar platerepair. The systems of the present invention include surgicalinstruments that confer enhanced repair (a tensioned plantar plate),while decreasing the chance of wound complications and plantar tissuetrauma.

An exemplary method of plantar plate repair employing a dorsal approachand combining a Weil osteotomy in accordance with the present inventioncomprises inter alia the steps of: Weil osteotomy is performed allowingthe capital fragment to be recessed under the metatarsal; digitaldistraction is obtained using a distraction clamp over K-wires; theplantar plate is assessed and repaired using suture (with a novel suturepassing hand instrument known as the Mini Scorpion™ DX suturepasser—this device allows the surgeon to pass suture through the plantarplate); the plantar plate is repaired back to the proximal phalanx.According to this method (the Complete Plantar Plate Repair or the CPRmethod), surgeons now have the option to repair the primary pathology,the plantar plate itself, using a dorsal approach.

Referring now to the drawings, where like elements are designated bylike reference numerals, FIGS. 1-13 illustrate surgical instruments ofthe system of the present invention employed during a method of plantarplate repair. FIGS. 14-42 illustrate exemplary steps of methods ofplantar plate repair 100 with the instruments of FIGS. 1-13.

FIGS. 1(a)-(c) illustrate various views of a Mini Scorpion™ DX 10employed for a plantar plate repair according to an embodiment of thepresent invention. The Mini Scorpion™ DX 10 includes the followingcomponents/features: Mini Scorpion™ DX tip-tube 1; Mini Scorpion™ DXactuator 2; Scorpion link 3; cutter tip 4 (for example, a 4.2 mmstandard cutter tip 4); Mini Scorpion™ DX jaw 5; Scorpion Fastpass trapdoor 6; Scorpion Fastpass trap door spring 7; tip pin 8 (for example, a4.5 mm tip pin 8); Scorpion thumb 9; Scorpion palm 10 a; Scorpion stoparm 11; Scorpion spring rod 12; Scorpion handle spring 13; reverse punchset screw 14; Scorpion finger 15; Scorpion finger spring 16; andScorpion handle pin 17.

FIGS. 2(a)-(d) illustrate various views of a Mini Scorpion™ DX needle 18with an exemplary nitinol welded tube 18 a and an exemplary moldedhandle 18 b (with a handle notch 18 d) employed with the Mini Scorpion™DX 10 of FIGS. 1(a)-(c). Mini Scorpion™ DX needle 18 is also providedwith a suture notch 18 c at its most distal end. FIG. 2(a) shows theinstrument 18 with the suture notch 18 c on right and the handle notch18 d on the bottom. The Mini Scorpion™ DX 10 and needle 18 function wellto pass a mattress stitch in the plantar plate, particularly in tightspaces.

FIGS. 3(a)-(d) illustrate various views of Micro SutureLasso™ suturepasser 20 according to an exemplary embodiment of the present invention.FIGS. 4(a)-(e) illustrate various views of Micro SutureLasso™ 22 suturepassers according to another exemplary embodiment of the presentinvention. FIGS. 5(a)-(d) illustrate various views of Micro SutureLasso™suture passers 20 a, 20 a′ according to yet other exemplary embodimentsof the present invention (with different curvatures of the distal shaftof the instrument). FIGS. 6(a)-(e) illustrate various views of MicroSutureLasso™ suture passer 20 b according to another exemplaryembodiment of the present invention. FIGS. 7(a)-(c) illustrate variousviews of Micro SutureLasso™ suture passer 20 c according to anotherexemplary embodiment of the present invention. FIGS. 8(a)-(b) illustratevarious views of Micro SutureLasso™ suture passer 20 d according toanother exemplary embodiment of Lassos 20 a, 20 b, 20 c, 20 d, 22 areparticularly useful in small-size patients and pass a mattress stitchmore proximally in the plantar plate.

FIG. 9(a) illustrates a side view of a Suture Retriever 30 provided withloop 31 (a Nitinol loop 31) and with stopper 33. FIG. 9(b) illustrates aside view of a Suture Retriever 30 a provided without stopper 33. Bothinstruments may be employed for the plantar plate repair of the presentinvention and are provided with Nitinol loop 31 to pull a flexiblestrand (for example, suture) through the bone tunnels.

FIGS. 10(a)-(b) illustrate an exemplary funnel 35 (sleeve 35) employedwith the Suture Retriever of FIGS. 9(a)-(b). The Suture Retriever 30, 30a and funnel 35 pass suture 71, 72 through the phalanx 80. Steps for aplantar plate repair with a suture retriever without a funnel 35 (sleeve35) are illustrated in FIGS. 16(a)-(c) which show how the Nitinol loop31 cannot be pushed and how the loop doubles back and drags behind (onthe plantar side, the wire must extend the length of the loop in orderfor it to be released). Steps for a plantar plate repair with a sutureretriever with a funnel 35 (sleeve 35) of the present invention areillustrated in FIGS. 17(a)-(c) which show a funnel 35 of only about 1.5inches long (to fit in a 1.1 or 1.6 mm K-wire hole). The smooth andflexible plastic sleeve 35 can be preloaded on the retriever or placedfree-hand. The sleeve 35 can slide up the retriever (in situ).

FIGS. 11(a)-(e) illustrate various views of a plantar plate Pusher 40which may be reusable or disposable and which may be employed to slidethe capital fragment back.

FIGS. 12(a)-(b) illustrate a plantar plate Measuring Guide 50 which ispreferably disposable.

FIG. 13 illustrates a plantar plate Distractor 60 (small jointDistractor 60).

The repair system of the present invention includes at least one of thefollowing instruments:

a metatarsal head pusher (such as plantar plate pusher 40) employed inopen surgical space, to move the “capital fragment” in a controlledmanner; this pusher has a specifically-designed head to prevent damageto the articular cartilage while pushing the fragment;a measuring guide (such as plantar plate measuring guide 50);a plantar plate distractor (such as plantar plate distractor60)—designed to work with k-wires to distract the joint;k-wires to work with the plantar plate distractor;flexible strands such as sutures—for example, FiberWire® suture 71, 72;a suture passer such as a Mini Scorpion™ DX 10 and accompanying needle18, or a set of Micro Suture Lassos™ 20, 20 a, 20 a′, 20 b, 20 c, 20 d,22;a suture retriever instrument (such as suture retriever 30, 30a)—Nitinol loop 31 to pull the suture 71, 72 through the bone tunnels;anda suture retriever sleeve or funnel (such as suture retrieval funnel35)—if used, this instrument ensures that the nitinol loop 31 on thesuture retriever 30, 30 a does not loop back.

FIGS. 14(a)-(d) illustrate subsequent steps of a method of plantar platerepair according to an embodiment of the present invention, illustratingsuture passer 10 (Mini Scorpion™ DX 10) and accompanying needle 18 andplantar plate distractor 60.

FIGS. 15(a)-(f) illustrate another series of subsequent steps of amethod of complete plantar plate repair according to an embodiment ofthe present invention:

FIG. 15(a): intraoperative demonstration of distraction of the secondMTP joint 99 with a plantar plate tear 77 (second metatarsal head 90 isinferior);

FIG. 15(b): a suture passer transfixing the plantar plate 70 (justproximal to the tear 77) and helping to pull the flexible strand 71, 72(for example, suture) through the plantar plate 70;

FIG. 15(c): two flexible strands 71, 72 (for example, two sutures 71,72) positioned at the distal aspect of the plantar plate (not yet passedthrough the phalanx);

FIG. 15(d): passing the flexible strands 71, 72 (sutures 71, 72) throughthe dorsal to plantar drill hole;

FIG. 15(e): fixation of metatarsal shortening (Weil) osteotomy beforetying the flexible strands 71, 72 (sutures 71, 72); and

FIG. 15(f): tying the flexible strands 71, 72 (sutures 71, 72) with thetoe in plantar flexion to form knots 71 a, 72 a of final repair 100 a.

An exemplary surgical technique for a plantar plate repair with theinstrument system of the present invention follows the exemplary stepsbelow:

1. A dorsal longitudinal incision is centered over the second web space.A longitudinal capsulotomy is performed just inferior to the tendons ofthe extensor digitorum longus and brevis to expose the affected secondMTP joint 99.

2. A partial collateral ligament release off of the proximal phalanx 80of the MTP joint 99 improves visualization.

3. A metatarsal shortening osteotomy (Weil osteotomy) is performed usinga sagittal saw. The saw cut is made parallel to the plantar aspect ofthe foot, starting at a point 2 to 3 mm below the top of the metatarsalarticular surface. The capital fragment is provisionally pushedproximally about 10 mm and fixed with a temporary vertical Kirschnerwire (k-wire), to hold it in a retracted position.

4. A second vertical Kirschner wire is then placed in the base of theproximal phalanx. A special plantar plate distractor 60 is placed overthe vertical wires and spread to expose the plantar plate 70.

5. The plantar plate tear 77 is evaluated and graded. Longitudinal tearsin the plate (grade 3) are repaired with a side-to-side interruptedsuture (for example, a 0-FiberWire®). Distal transverse tears (grades 1and 2) are repaired by placing the same suture in the distal plantarplate. The distal plantar edge of the proximal phalanx is roughened witha burr or curette to prepare a surface for reimplantation of the plantarplate. The distal plantar plate is transfixed just proximal to thetransverse tear using a small curved needle or a special curved MicroSutureLasso™ suture passer such as, for example, Micro SutureLasso™suture passer 20 of FIGS. 3(a)-(d), or a suture passing instrument suchas, for example, Mini Scorpion™ DX suture passer 10 of FIGS. 1(a)-(c) topass the flexible strand 71, 72 (suture 71, 72) within the restrictedMTP joint surgical area of exposure.

6. Using a 1.6-mm drill or k-wire, two parallel drill holes are createdmedially and laterally on the proximal phalanx 80, directed from thedorsal cortex of the proximal phalanx to the plantar rim of the proximalphalanx. This permits passing of a suture, plantar to dorsal, to fix theplantar plate 70 to its insertion point at the plantar base of thephalanx 80.

7. The metatarsal shortening (Weil) osteotomy is then reduced (tosurgeon's desired position). It is fixed in optimal position with one ortwo small screws or k-wire.

8. The toe is held reduced on the metatarsal articular surface, inplantar flexion, and with tension on the sutures 71, 72 (having beenpulled through the holes in the proximal phalanx 80). They are tied overthe dorsal phalangeal cortex, thus advancing the plantar plate onto thebase of the proximal phalanx.

9. A lateral soft tissue reefing to repair the lateral collateralligamentous release is performed with nonabsorbable sutures.

10. An interrupted wound closure is performed. The foot is placed intape compression dressing with the digit held in 10° to 15° of plantarflexion.

FIGS. 18-42 illustrate the steps of a plantar plate repair with theinstruments of the present invention in accordance with anotherembodiment of the invention:

FIGS. 18 and 19: The tear 77 is visualized; if more than 40% is torn,detach the plantar plate 70 from the rim of the proximal phalanx 80 (anelevator may be optionally used).

FIGS. 20-23: A metatarsal shortening osteotomy is performed withosteotome 75. Use the metatarsal pusher 40 to push the plantar fragmentbetween 8-10 mm away from the joint 99 and provisionally fixate with 1.6mm threaded or non-threaded k-wire 76.

FIGS. 24 and 25: Optionally, based on pre-operative measurements, atemplate can be used to cut the dorsal shelf of the metatarsal to aspecific length using a bone cutter. This will allow bettervisualization and access to the plantar plate 70.

FIGS. 26-28: A unique plantar plate distractor 60 with 1.6 or 2.0 mmthreaded or non-threaded k-wires is then placed in the phalanx 80 andthe metatarsal 90 and distracts the joint 99.

FIGS. 29 and 30: Create a noose 71 a at the end of the flexible strand71 (#0 FiberWire® suture 71) and load it into the Mini Scorpion™ DXsuture passer 10.

FIGS. 31 and 32: Fire the needle 18 medial and lateral, creating aninverted mattress stitch 78 in the plantar plate 70. The step isrepeated for two independent sutures 71, 72 in the plantar plate 70.

FIGS. 33-36: Remove the distractor 60 and use a towel clamp 62 toplantar flex the phalanx 80. Two crossing drill holes 82 using a 1.6 mmk-wire 82 are made in the proximal phalanx 80. This allows passing asuture 71, 72 plantar to dorsal, to fix the plantar plate 70 to itsinsertion point at the plantar base of the phalanx 80. The k-wire exitsthe phalanx just below the cartilage (arrows A of FIG. 35). This allowsfor easier suture passing.

FIGS. 37-39: Pass the sutures 71, 72 using the Micro Suture Lasso™suture passer 20. The suture passer must not flip back on itself whenpassing in the hole. A mosquito may be used to aid in the passing of thesutures 71, 72 into the suture passer.

FIGS. 40 and 41: Weil osteotomy is then fixed in optimal position withone or two fixation devices 92 (such as 2.0 mm Quickfix screws 92 or anyscrew or pin). The toe is held in the optimal position and both sets ofsuture ends 71, 72 are tied over the phalanx 80 forming knots 71 a, 72 a(FIG. 42).

FIG. 42 shows the final repair 100.

The flexible strands 71, 72 may be made of any known suture material,such as ultrahigh molecular weight polyethylene (UHMWPE) or theFiberWire® suture (disclosed in U.S. Pat. No. 6,716,234 which is herebyincorporated by reference in its entirety).

While the present invention is described herein with reference toillustrative embodiments for particular applications, it should beunderstood that the invention is not limited thereto. Those havingordinary skill in the art and access to the teachings provided hereinwill recognize additional modifications, applications, embodiments andsubstitution of equivalents all fall within the scope of the invention.Accordingly, the invention is not to be considered as limited by theforegoing description.

What is claimed is:
 1. A method of plantar plate repair, comprising:exposing a metatarsophalangeal joint affected by a plantar plate tear;distracting the metatarsophalangeal joint to expose a plantar plate,wherein distracting the metatarsophalangeal joint includes placing afirst k-wire in a metatarsal bone of the metatarsophalangeal joint,placing a second k-wire in a phalangeal bone of the metatarsophalangealjoint, placing a distractor over the first k-wire and the second k-wire,and then spreading the distractor to expose the plantar plate, whereinplacing the distractor over the first k-wire and the second k-wireincludes sliding a first housing of the distractor down over the firstk-wire and sliding a second housing of the distractor down over thesecond k-wire, wherein the distractor includes a first handle, a firstarm that extends from the first handle, a second handle, a second armthat extends from the second handle, and a pivot pin extending throughthe first arm and the second arm, wherein each of the first handle andthe second handle includes an oblong shaped finger opening disposed at aproximal most end of the distractor; passing a first suture portion anda second suture portion through the plantar plate; removing thedistractor, the first k-wire, and the second k-wire; drilling a firsthole and a second hole through the phalangeal bone, wherein the firsthole and the second hole are crossing drill holes; passing the firstsuture portion through the first hole; passing the second suture portionthrough the second hole; and tying the first suture portion and thesecond suture portion together with a knot, thereby advancing theplantar plate onto the phalangeal bone.
 2. The method as recited inclaim 1, comprising: performing an osteotomy to the metatarsal boneprior to distracting the metatarsophalangeal joint.
 3. The method asrecited in claim 2, comprising: pushing a capital fragment of themetatarsal bone away from the metatarsophalangeal joint.
 4. The methodas recited in claim 2, comprising: fixating the osteotomy with at leastone fixation device.
 5. The method as recited in claim 1, whereinexposing the metatarsophalangeal joint includes: performing a dorsallongitudinal incision over the metatarsophalangeal joint.
 6. The methodas recited in claim 1, comprising: roughening a surface of thephalangeal bone to prepare the surface for reattachment of the plantarplate prior to drilling the first hole and the second hole.
 7. Themethod as recited in claim 1, wherein passing the first suture portionand the second suture portion includes: creating an inverted mattressstitch in the plantar plate.
 8. The method as recited in claim 1,wherein the first suture portion and the second suture portion are partof separate sutures.
 9. The method as recited in claim 1, wherein thefirst k-wire is received within either a proximal passage or a distalpassage of the first housing and the second k-wire is received withineither a proximal passage or a distal passage of the second housing. 10.The method as recited in claim 9, wherein the distal passages include alarger diameter than the proximal passages.
 11. The method as recited inclaim 1, wherein the first housing extends from the first arm of thedistractor and the second housing extends from athe second arm of thedistractor, wherein the first housing and the second housing areenlarged relative to the first arm and the second arm, respectively. 12.The method as recited in claim 1, comprising: releasing the plantarplate from the phalangeal bone prior to distracting themetatarsophalangeal joint.
 13. The method as recited in claim 1, whereindistracting the metatarsophalangeal joint includes: spreading distalportions of the distractor apart to move the metatarsal bone and thephalangeal bone apart from one another, thereby exposing the plantarplate.
 14. The method as recited in claim 1, wherein the first k-wire ispositioned in the metatarsal bone before positioning the second k-wirein the phalangeal bone.
 15. The method as recited in claim 1, whereinthe first k-wire is positioned in the metatarsal bone after positioningthe second k-wire in the phalangeal bone.
 16. A method of plantar platerepair, comprising: exposing a metatarsophalangeal joint; distractingthe metatarsophalangeal joint to expose a plantar plate, whereindistracting the metatarsophalangeal joint includes spreading adistractor to move a first k-wire that is positioned in a metatarsalbone and a second k-wire that is positioned within a phalangeal boneaway from one another, thereby exposing the plantar plate, wherein thedistractor includes a first handle, a first arm that extends from thefirst handle, a second handle, a second arm that extends from the secondhandle, and a pivot pin extending through the first arm and the secondarm, wherein each of the first handle and the second handle includes anoblong shaped finger opening disposed at a proximal most end of thedistractor, wherein distracting the metatarsophalangeal joint includessliding a first housing of the distractor down over the first k-wire andsliding a second housing of the distractor down over the second k-wireprior to spreading the distractor; passing a suture through the plantarplate; removing the distractor, the first k-wire, and the second k-wire;drilling a hole through the phalangeal bone; passing the suture throughthe hole; and tensioning the suture relative to the phalangeal bone toadvance the plantar plate onto the phalangeal bone.